Cardiology Flashcards
Compression and ventilation rate during CPR
8-10 breaths during CPR
15:2, 100-120 compressions/ minute
Characteristics of effective CPR
push hard (1/3 chest diameter), fast (100-120), full chest recoil, minimize interruptions (< 10 sec), change rescuers every 2 minutes
List 4 drugs that can be given via ETT
LEAN (lidocaine, epinephrine, atropine, naloxone)
10X usual dose of epi: 0.1 mg/kg of 1:10000
Which size of pads to use on defibrillator?
Adult pads of defibrillator can be used for > 1 year old, weight > 10 kg
Infant pads if < 1 year old / 10 kg
Which dose to use on AED?
> 8 years old: deliver adult dose (150-200J)
1-8 years (< 25kg): use dose-attenuation if available - delivers 50J
< 1 year old – manual defib preferred, but use AED if that’s all that’s available (insufficient evidence)
Good prognostic factors for CPR (list 5)
o In hospital arrest (witnessed)
o Early recognition/intervention and initiation of CPR
o High quality CPR
o Good post arrest myocardial function
o Good health status prior to arrest/no underlying cardiac pathology
o ?Return of ROSC in <30 min
Medications to use to treat SVT
Adenosine is 1st line
Alternatives = verapamil (CCB, myocardial depression/arrest), procainamide, digoxin, beta-blockers
List the types of shock (list 6)
o Obstructive (tamponade, PTX, PE, CHD)
o Hypovolemic (hemorrhage, fluid loss, burns)
o Cardiogenic
o Distributive (sepsis, anaphylaxis, drug ingestions)
o Neurogenic
o Dissociative
Formula to calculate blood pressure
BP = CO x SVR
CO = SV x HR
SV depends on preload, afterload, contractility
Characteristics of warm vs. cold shock
‘Cold’ Shock: mottled skin, cool extremities, prolonged capillary refill, weak pulses. Most common in pediatric patients.
‘Warm’ Shock: warm extremities, flash cap refill, bounding pulses, wide pulse pressure. Most common in adults.
Definition of SIRS
Inflammatory response with 2 or more of following criteria (one of which must be abnormal temperature or leukocyte count):
a. Core temperature >38.5°C or <36°C
b. Tachycardia (or bradycardia if younger than 1 year of age)
c. Tachypnea
d. Increased or decreased leukocyte count
3 ways to administer IV fluids rapidly
push-pull syringes, rapid infuser, pressure bag
First line vasopressor
o Cold shock: epinephrine
o Warm shock: norepinephrine
Management of catecholamine-resistant shock
o Sedate and ventilate (avoid etomidate in septic shock)
o Stress-dose steroids (50-100 mg/m2 of hydrocortisone)
o ECMO
Work-up of cyanotic patient
o Arterial PO2
o CBC, metHg level, Carboxyhemoglobin (co-oximetry)
o +/- blood cultures
o +/- CXR, EKG, echo
List 6 cyanotic CHD’s
truncus arteriosus TGA tricuspid atresia TOF TAPVD HLHS critical AS, PS pulmonary atresia with intact ventricular septum
List 4 characteristics of pathologic murmurs
- diastolic
- grade 3 and above
- radiates to axilla, carotids
- harsh quality
- heart sounds obscured
- doesn’t change with position
Physical exam findings of mitral valve prolapse
Mid-systolic click and late systolic murmur
Cardiac findings of Marfan’s
aortic dilation/ dissection
mitral valve prolapse (up to 50%)+ cardiomyopathy with bilateral ventricular enlargement
Drug/tox causes of chest pain
cocaine, methamphetamine, nicotine, triptans, cold medicines, herbal meds
What is Tietze syndrome?
benign inflammation of costochondral junction (looks like a mass on the chest wall)
What is slipping rib syndrome?
8-10th ribs attached by fibrous band and rub on each other. Popping/clicking, exacerbate pain by hooking lower ribs by the hand and pulling anteriorly
What are the characteristics of precordial catch?
common in healthy teens, very brief sharp twinges of chest pain, often relived by position (ie. sitting up straight)
Red flags for chest pain in children (list 6)?
acute, crushing, radiation to left arm, awakens at night, associated with exertion, syncope, fever, fatigue, dyspnea, decreased exercise tolerance, palpitations
- associated with high risk conditions – KD, CF, collagen vascular disease, malignancy
- Family history of sudden cardiac death
- Drug use
Clinical characteristics and treatment of POTS?
postural orthostatic tachycardia syndrome. Teen girls, chronic fatigue, orthostatic tachycardia, without hypotension. Dx with tilt-table testing
Treatment: hydration, avoid caffeine, inc. salt intake, elevate HOB, reconditioning program
Most common arrhythmia of childhood?
Premature atrial contractions (PAC’s)
List 3 concerning features of PVC’s?
o Multiform/multifocal PVC’s (ie more than one shape) – may indicate CPVT or ARVD
o PVC’s occurring in couplets
o Increased frequency with exercise
List 5 cardiac conditions associated with PVC’s
● Prolonged QT interval ● Cardiomyopathy ● Myocarditis ● Myocardial contusion ● MI/Ischemia ● Mitral valve prolapse ● Ebstein's anomaly ● Cardiac tumours ● Post operative state (especially Tetralogy of Fallot)
List 5 NON-cardiac causes of PVC’s
● Hypoxia and or hypercapnia ● Acidosis ● Hypoglycemia ● Hypokalemia ● Hypomagnesemia ● Hypercalcemia ● Medications – digoxin, phenothiazines, sympathomimetics
List 4 ingestions associated with palpitations
caffeine, diet supplements, herbal preparations, sympthomimetics, cocaine, amphetamines
List 3 non-cardiac causes of palpitations/ tachycardia
anemia, anxiety, exercise, fever, drug-induced, emotional arousal
How to measure QTc (and name of the formula)
QTc = QT/ sq(RR) > 450 msec (Bazzett’s formula)
measure in lead II or V5/V6
List 5 acquired causes of long QT
HypoMg, hypoK, HypoCa, hypothyroidism, eating disorders, drugs (sotalol, haloperidol, methadone, pentamidine + many others)
Activity recommendations for long QT
- No driving
- No swimming unattended
- No baths unattended
- Avoid intense exercise
- Until type of Long QT identified: No diving into cold water, loud or sudden noises
Starting dose of prostaglandins, and list 3 side effects
0.05-0.1 mcg/kg/min (0.01 only if known open ductus, not in shock)
Titrate until palpable femoral pulses, or O2 sats improve. Effect seen within 30 min
Side effects: hypotension, apnea, fever, rash
3 stages of palliation for HLHS?
- Norwood/BT shunt at birth– subclavian to pulmonary artery
- Bidirectional Glenn at 3-6 months – SVC to pulmonary artery
- Fontan at 2 years old – SVC and IVC to PA
How to perform hyperoxia test
apply 100% O2 for 10 min then perform an ABG
o PO2 > 150 = normal
o PO2 < 100 = CHD
Pathophysiology and treatment of a Tet spell
acute increase of RVOTO, preventing blood flow to the lungs. All blood then shunted R –> L, extreme cyanosis.
o Knees to chest / squatting (increases SVR)
o 100% oxygen
o Morphine 0.1 mg/kg (dec agitation)
o NS bolus 5-10 cc/kg (inc preload)
o IV phenylephrine infusion (alpha-agonist, inc SVR)
o Propanolol (beta blocker, relaxes infundibular septum)
When NOT to give adenosine
Do NOT give adenosine to wide complex, irregular rhythm ie. A.fib with WPW –> blocking AV node can allow conduction via accessory pathway –> V fib.
List complications/ contraindications to adenosine
- A. fib with WPW ie. Wide complex irregular rhythm (can lead to V. fib)
- heart transplant (give 1/3 regular dose)
- may cause bronchospasm in asthmatics
4 causes of wide complex, regular tachycardia
VT
SVT with aberrancy
sinus tachycardia with aberrancy/ BBB
antidromic WPW
List 4 causes of sinus bradycardia
sick sinus syndrome, intoxication (beta-blockers, CCB, seizure meds, sedation meds), hypothyroidism, anorexia nervosa, myocarditis, PAC’s
List 4 causes of sudden cardiac death
- Hypertrophic cardiomyopathy (HCM)
- ALCAPA – can present in infancy when PVR drops, or later in life with ischemic symptoms, SCD
- Channelopathies: CPVT, LQTS, Brugada syndrome
- WPW (0.1 % - a. fib –> VF through accessory pathway)
List 4 symptoms of CHF in a neonate
tachypnea, tachycardia, hepatomegaly, cardiomegaly, crackles, feeding difficulty
Etiology of myocarditis?
Viral #1 (coxsackie, echovirus, adenovirus, EBV, CMV), also autoimmune, meds, toxic, vasculitis
Clinical characteristics of myocarditis?
Tachycardia out of proportion to fever, pallor, cyanosis, resp distress, muffled heart sounds, gallop rhythm, hepatomegaly
EKG changes seen in myocarditis?
sinus tachycardia, low voltage QRS complexes, inverted or low-voltage T-waves
Etiology of pericarditis?
- Usually viral cause (coxsackie, echovirus, adenovirus, influenza)
- Bacterial causes: Staph aureus, strep pneumoniae, H. flu, N. meningidites, TB
- Other causes: post-pericardiotomy syndrome, acute rheumatic fever
4 stages of EKG in pericarditis?
- diffuse ST elevation and PR depression
- normalizing ST and PR intervals
- T waves flatten –> invert
- T waves normalize
CXR and echo findings in pericarditis?
CXR: cardiomegaly, or normal, pulmonary edema if failure
Echo: pericardial effusion, +/- tamponade, dec contractility
What are the components of Beck’s triad? What condition is it associated with?
Tamponade
hypotension, muffled heart sounds, JVD
4 indications for the use of amiodarone?
pulseless Vtach, Vtach with a pulse, V fib, SVT with aberrancy / transient responsive to adenosine (2nd/3rd line agent)
What is the mechanism of action of amiodarone, how can it induce arrest?
Class 3 antiarrhythmic – K channel blocker. Prolongs QT interval and can induce arrest
4 complications of myocarditis?
- Dilated cardiomyopathy (acute)
- CHF
- Pulmonary edema
- Arrhythmias, cardiac arrest
4 basic steps of using an AED?
POWER ON the AED Attach electrode pads Analyze rhythm Charge the Shock Clear the victim and press the SHOCK button
List 5 cardiac problems in Anorexia nervosa
Structural changes ● Decreased cardiac mass ● Reduced cardiac chamber volumes ● Mitral valve prolapse ● Myocardial fibrosis ● Pericardial effusion
Functional changes ● Bradycardia ● Hypotension ● QT dispersion (variability in QT interval between ECG leads) ● Diminished heart rate variability ● Long QT syndrome
List 2 endocrine causes, 2 drug/toxin causes and 2 cardiac causes of palpitations.
2 endo: hyperthyroidism, pheochromocytoma, hypoglycemia
2 drugs, toxins: anticholinergics(benadryl, atropine), sympathomimetics (cocaine, methamphetamines)
2 cardiac: SVT, ventricular tachycardia
List 8 causes of PEA
H's and T's: ● hypoxia ● hypo/hyperkalemia ● H+ ions (acidosis) ● hypovolemia ● hypoglycemia ● hypothermia ● Toxins ● Trauma ● Tension pneumothorax ● Tamponade ● Thrombosis
Dose for synchronized cardioversion?
1st attempt -> 0.5-1 joule per kg
Dose of epinephrine in cardiac arrest
0.01mg/kg or 0.1ml/kg of 1:10,000
Dose for defibrillation?
2-4J/kg
What is the calculation for circulating blood volume in neonates?
80 ml/kg
When is hypotension seen in children with acute blood loss?
Hypotension is a late finding in acute blood loss occurring in Class III or class IV hemorrhagic shock (>30% total blood volume loss)
2 cardiac complications of JIA?
Pericarditis, small Pericardial effusion, myocarditis, KD-like: coronary artery dilatation
2 cardiac complications of sickle cell?
Cardiomyopathy (resulting in MI and decreased output), LVH, 1st degree block, prolonged QT, nonspecific ST-T wave changes
Incidental murmur in 3 month old baby- what 2 things on history that make you concerned for significant congenital heart disease
episodes of cyanosis/hypoxia/diaphoresis
failure to thrive (poor weight gain or poor feeding)
